Center for Health Services Research, National University of Singapore, Singapore.
BMC Med. 2009 Dec 10;7:76. doi: 10.1186/1741-7015-7-76.
Individual strategies in pandemic preparedness plans may not reduce the impact of an influenza pandemic.
We searched modeling publications through PubMed and associated references from 1990 to 30 September 2009. Inclusion criteria were modeling papers quantifying the effectiveness of combination strategies, both pharmaceutical and non-pharmaceutical.
Nineteen modeling papers on combination strategies were selected. Four studies examined combination strategies on a global scale, 14 on single countries, and one on a small community. Stochastic individual-based modeling was used in nine studies, stochastic meta-population modeling in five, and deterministic compartmental modeling in another five. As part of combination strategies, vaccination was explored in eight studies, antiviral prophylaxis and/or treatment in 16, area or household quarantine in eight, case isolation in six, social distancing measures in 10 and air travel restriction in six studies. Two studies suggested a high probability of successful influenza epicenter containment with combination strategies under favorable conditions. During a pandemic, combination strategies delayed spread, reduced overall number of cases, and delayed and reduced peak attack rate more than individual strategies. Combination strategies remained effective at high reproductive numbers compared with single strategy. Global cooperative strategies, including redistribution of antiviral drugs, were effective in reducing the global impact and attack rates of pandemic influenza.
Combination strategies increase the effectiveness of individual strategies. They include pharmaceutical (antiviral agents, antibiotics and vaccines) and non-pharmaceutical interventions (case isolation, quarantine, personal hygiene measures, social distancing and travel restriction). Local epidemiological and modeling studies are needed to validate efficacy and feasibility.
大流行防范计划中的个别策略可能无法减轻流感大流行的影响。
我们通过 PubMed 搜索了 1990 年 9 月 30 日至 2009 年 9 月 30 日的建模出版物，并查阅了相关参考文献。纳入标准是定量评估药物和非药物联合策略有效性的建模论文。
共选择了 19 篇关于联合策略的建模论文。四项研究在全球范围内评估了联合策略，14 项研究在单一国家进行，一项研究在小型社区进行。9 项研究采用了随机个体为基础的建模，5 项研究采用了随机元种群建模，另外 5 项研究采用了确定性房室模型。作为联合策略的一部分，有 8 项研究探讨了疫苗接种，16 项研究探讨了抗病毒预防和/或治疗，8 项研究探讨了区域或家庭检疫，6 项研究探讨了病例隔离，10 项研究探讨了社会隔离措施，6 项研究探讨了航空旅行限制。两项研究表明，在有利条件下，联合策略有很大可能成功控制流感中心。在大流行期间，与单一策略相比，联合策略可延迟传播、减少总病例数、延迟和降低峰值发病率。与单一策略相比，高繁殖数时联合策略仍然有效。包括重新分配抗病毒药物在内的全球合作策略可有效减少大流行性流感的全球影响和发病率。
联合策略可提高个别策略的效果。这些策略包括药物（抗病毒药物、抗生素和疫苗）和非药物干预（病例隔离、检疫、个人卫生措施、社会隔离和旅行限制）。需要进行局部流行病学和建模研究以验证其疗效和可行性。
